Travel Smart Consultancy Voucherclaim Form

TRAVEL SMART CONSULTANCY VOUCHERCLAIM FORM

(“Claim Form”)

Please read the following instructions carefully before completing this form.

Consultants can only submit claims for work carried out under the Travel Smart Consultancy Voucher for organisations who have been successful in their previous Travel Smart Consultancy Voucher application. By submitting this form, the appointed consultant (“Consultant”) and the applicant organisation (“Organisation”)agree to the terms and conditions of the Land Transport Authority of Singapore (“LTA”) set out herein.

All fields in this application are compulsory. Where information is not applicable, a “N.A.” is necessary.

The Consultant should also ensure that the necessary approvals from the Organisation have been obtained with regards to the finalised reports/documentation as part of thisClaim Form, and submit relevant supporting documents.

Upon obtaining the Organisation’s endorsement, the Consultant shall submit the completed Claim Form and the relevant supporting documents to:

Land Transport Authority of Singapore
10 Sin Ming Drive, Level 5
Singapore 575701
Attn: Travel Smart Project Team, Public Transport Promotion

The Organisation shall, within 1 year from the date of the submission of the reports/documentation set out in Section 3 herein to LTA, apply for the Travel Smart Grant by completing and submitting the Travel Smart Grant Application Form as annexed hereto at Annex A or set out in such document(s) and/or form(s) as otherwise provided by LTA.In the event the Organization fails to do the foregoing, the Organization shall forthwith pay and/or return to LTA all monies incurred by LTA in connection with the Travel Smart Consultancy Voucher and/or the Travel Smart Grant Programme.

LTA reserves the right to reject the Claim Form at its sole discretion and for any reason, including without limitation if the submission is incomplete. In addition, LTA reserves the right not to entertain any appeals.

Payment will only be made to the Consultant upon approval of this completed Travel Smart Consultancy Voucher Claim Form.

In-principal approval ofeach of the Travel Smart Consultancy Voucher Claim Form does not guarantee reimbursement. The Consultant shall show supporting documents (reports/documentation)to demonstrate that the Organisation has received the necessary deliverables required under the Travel Smart Consultancy Voucher.

LTA reserves the right to audit successful claimants at anytime within 1 year after the claim to ensure that the work required for the Travel Smart Consultancy Voucher has been carried out appropriately. The relevant supporting documents are to be retained for up to 6 months from the date the monies from the Travel Smart Consultancy Voucher are disbursed from LTA to the Consultant.

If the Consultant’s Travel Smart Consultancy Voucher Claim Form is approved and monies from the Travel Smart Consultancy Voucher has been disbursed to the Consultant, and it is subsequently discovered that the Consultant and/or Organisation has caused the monies to be disbursed to it by false or misleading means, the Consultant shall within seven (7) days of LTA’s written demand thereof, return ALL monies disbursed from the Travel Smart Consultancy Voucher to LTA as demanded.

The Consultant and the Organisation shall ensure that all necessary consents have been procured for LTA to collect, use and disclose any personal data provided to LTA for the purpose of carrying out all aspects of the Travel Smart project in relation to the Organisation’s participation in such project. The Consultant and/or the Organisation (as the case may be) shall promptly inform LTA of any withholding or revocation of consent by anyone for LTA to collect, use and/or disclose any personal data. The Consultant and the Organisation recognise that such withholding/revocation of consent may hinder the performance of some or all aspects of the Travel Smart project (including the processing of any claims) and shall not hold LTA liable for any circumstances or consequences arising directly or indirectly from such withholding/revocation of consent.

The Organisation hereby gives LTA an exclusive, perpetual and royalty-free right and licence to use, adapt, edit, display, modify, publish or otherwise make use of the Travel Smart measures (whether in whole or in part) as stated by the Organisation in this Application Form and/or in connection with the Travel Smart Grant.

For all queries pertaining to the Travel Smart Consultancy Voucher, organisations are to email:

Section 1 –DETAILS OF APPOINTED CONSULTANT

To be completed by the representative of the appointed Consultant

i)Name of Consultant
ii)Name & IC/Passport No. of Project Director
iii)Name & Contact Details of Main Contact Person For Application

Section 2 –Details OFAPPLICANT ORGANISATION

To be completed by the appointed Travel Smart Leader of the Organisation

i)Organisation
ii)Name & IC/Passport No. of Travel Smart Leader / iii)Designation
iv)DID & HP No. / v)Email
vi)Travel Smart Consultancy Voucher Application No.

Section 3 –Details OF CLAIM

To be completed by the Consultant with the endorsement of the Organisation

i)Allowable Travel Smart Consultancy Voucher Funding Quantum
ii)Total Payment (Cumulative Claim) [1]
iii)Less Previously Certified [2]
iv)Payment Due (Current Claim) [3]
v)GST Due (7%)
vi)Total (Including GST)

Breakdown of Claims

Item

Description

% of Allowable Quantum

Amount

(S$)

Previously Certified [4]

(S$)

[A]

Current Claim [5]

(S$)

[B]

Cumulative Claim [6]

(S$)

[A] + [B]

Remarks

Receipt of Report & Documentation: Needs Gathering and Travel Survey

20%

Acceptance of Report & Documentation: Needs Gathering and Travel Survey

30%

Receipt of Report & Documentation: Needs Interim Travel Demand Action Plan

20%

Acceptance of Report & Documentation: Needs Final Travel Demand Action Plan

30%

Grand Total

Notes:

Copies of the above-mentioned reports/documentation must be attached together with this claim form.
The endorsement of the Organisation’s Travel Smart Leader under Section 5 is required when claiming for Items2 and 4.

Section 4 – Declaration

To be completed by appointed Consultant

Yes / No

The Consultant is solvent and no liquidation or winding-up proceedings have been commenced or are pending against it.

There are no unsatisfied judgments outstanding against the Consultantthat will materially impact the solvency of the Consultant.

Neither the Consultantnor its proprietor (in the case of a sole proprietorship), directors (in the case of a corporation), partners (in the case of a partnership, limited partnership or limited liability partnership) or members (in the case of any other unincorporated association) has/have been convicted of any offence involving fraud, misrepresentation and/or dishonesty.

There have been/are no prosecutorial or civil proceedings commenced/pending against the Consultantor its directors (in the case of a corporation), partners (in the case of a partnership, limited partnership or limited liability partnership) or members (in the case of any other unincorporated association), in the last 10 years preceding the date of this declaration for fraud, misrepresentation and/or dishonesty.

The Consultantand/or its directors, shareholders, employees or any other person related to the aforesaid persons has/have not been given any monies, loans, rebates, discounts, refunds, liquidated damages or any other payment, whether in cash or in kind, by the Organisation or their directors, shareholders, employees or any other person related to the aforesaid persons, in connection with the Travel Smart programme or this application form; and there is no intention to give such monies, loans, rebates, discounts, refunds, liquidated damages or any other payment.

The facts stated in this application and the accompanying information are true, complete and correct to the best of my/our knowledge and belief and that I/we have not withheld/distorted any material facts.

I/We understand that if I/we obtain the grant by false or misleading statements, I/we may be prosecuted, and in addition, LTA may, at its discretion, withdraw or cancel the voucher in full or in part and recover immediately from the Consultant any amount that may have been disbursed.
Signature & Organisation Stamp
Note: Only the designated Project Director from the appointed Consultant may sign this declaration. / Name
Designation
Date

Section 5 – ORGANISATION’s ENDORSEMENT

To be completed by the appointed Travel Smart Leader of the Organisation

Yes / No

I/We hereby certify that the Consultant has carried out the highlighted work as detailed in this work and are thus eligible for the respective claims.

The Consultant and/or its directors, shareholders, employees or any other person related to the aforesaid persons has/have not been given any monies, loans, rebates, discounts, refunds, liquidated damages or any other payment, whether in cash or in kind, by the Organisation or their directors, shareholders, employees or any other person related to the aforesaid persons, in connection with the Travel Smart programme or this application form; and there is no intention to give such monies, loans, rebates, discounts, refunds, liquidated damages or any other payment.

I/We understand that exchange of such monies, loans, rebates, discounts, refunds, liquidated damages or any other payment without seeking LTA’s approval may constitute an offence by law (including under the Penal Code and/or the Prevention of Corruption Act).
Signature & Organisation Stamp
Note: Only the designated Travel Smart Leader from the Organisation (as nominated in the previously approved Travel Smart Consultancy Voucher application) may sign this declaration. / Name
Designation
Date

Annex A: Travel Smart Grant Application Form

TRAVEL SMART GRANT APPLICATION FORM

(“Application Form”)

Please read the following instructions carefully before completing this form.

Only organisations participating in LTA’s Travel Smart Network can apply for the Travel Smart Grant. By submitting this form, the applicant organisation (“Organisation”) agrees to the terms and conditions of the Land Transport Authority of Singapore (“LTA”) as set out herein (which includes the Information Sheet for Travel Smart Grant and its annexures).

All fields in this application are compulsory. Where information is not applicable, a “N.A.” is necessary.

The Organisation should demonstrate that the items/services to be reimbursed and listed in its Application Form are either:
Travel Smart measures proposed as part of their travel demand management action plan (developed using the Travel Smart Consultancy Vouchers); or
Self-proposed Travel Smart measures (without using the Travel Smart Consultancy Vouchers) which they have pre-consulted with LTA and are substantiated with supporting employee survey data (surveys to be carried out not more than 1 year before date of application indicated in this form).

Notes: Priority will be given to companies who already have travel demand actions plans that have been previously approved by LTA as part of the Travel Smart Consultancy Voucher.

They should also ensure that the proposed Travel Smart measures mentioned above fulfil at least one of the Travel Smart objectives, which are:

Re-time: travel during off-peak periods
Reduce: travel demand (i.e. work off-site/at home instead of travelling to office)
Re-mode: switch to more sustainable modes of travel (public transport, cycling and/or walking)

For Organisations that are applying for the 2nd or 3rd funding year of the Travel Smart Grant, a copy of the Post-Implementation Survey results has to be attached to this application.

All supporting documents listed below must be submitted together with the Application Form:

ACRA Search/Business Profile Search dated within 1 year of application date (where applicable);
Vendors’ quotation for the items relating to each Travel Smart measure the organisation is seeking funding for;
Post-Implementation Survey results (where applicable); and
Employee survey data (where applicable).

The Organisation shall submit the completed Application Form to:

Land Transport Authority of Singapore
10 Sin Ming Drive, Level 5
Singapore 575701
Attn: Travel Smart Project Team, Public Transport Promotion

Once the Organisation’s Application Form is approved by LTA, the Organisation should note that the Travel Smart Grant Reimbursement Form must be submitted to LTA no later than 1 year from the date of approval as communicated by LTA.

If the Organisation wishes to amend or propose additional measures for each funding year, submission of the revised Application Form must take place no later than 6 months after the approval of the original Application Form.

If the Organisation wishes to extend the submission deadline for the Travel Smart Grant Reimbursement Form, they must seek LTA’s approval in writing together with the appropriate justifications.

LTA reserves the right to reject the Application Form at its sole discretion and for any reason, including without limitation if the submission is incomplete. In addition, LTA reserves the right not to provide unsuccessful applicants with details of their rejection or entertain any appeals.

The issuance by LTA of a Letter of Acceptance accepting the Application Form shall create a binding Contract between LTA and the organisation on the terms and conditions as set out in this Application Form (which includes the Information Sheet for Travel Smart Grant and its annexures). Such issuance of the Letter of Acceptance, whether through email or by hand or by post, shall be deemed effective communication of acceptance.

The Organisation shall notify LTA in writing if there are any changes in their nominated Travel Smart Leader.

All confidential information provided by LTA to the Organisation in connection with the Travel Smart Programme shall be treated by the Organisation on a confidential basis.

The Organisation intending to make any press release, public announcements or other publicity materials or disclosure of any matter relating to the Travel Smart Programme shall seek LTA’s prior written consent.

The Organisation shall ensure that all necessary consents have been procured for LTA to collect, use and disclose any personal data provided to LTA for the purpose of carrying out all aspects of the Travel Smart project in relation to the Organisation’s participation in such project. The Organisation shall promptly inform LTA of any withholding or revocation of consent by anyone for LTA to collect, use and/or disclose any personal data. The Organisation recognises that such withholding/revocation of consent may hinder the performance of some or all aspects of the Travel Smart project (including the processing of any claims) and shall not hold LTA liable for any circumstances or consequences arising directly or indirectly from such withholding/revocation of consent.

The Organisation hereby gives LTA an exclusive, perpetual and royalty-free right and licence to use, adapt, edit, display, modify, publish or otherwise make use of the Travel Smart measures (whether in whole or in part ) as stated by the Organisation in this Application Form and/or in connection with the Travel Smart Grant.

For all queries pertaining to the Travel Smart Grant, organisations are to email:

Section 1 – APPLICANT Details

To be completed by the appointed Travel Smart Leader of the participating Organisation

i)Organisation
ii)Name & IC/Passport No. of Travel Smart Leader / iii)Designation
iv)DID & HP No. / v)Email
vi)No. of Employees
(according to office location)
vii)Travel Smart Consultancy Voucher Application No.
(if applicable)
Has Organisation Applied for the Travel Smart Grant Previously? / ( Yes / No )
If Yes, Please Indicate the Previous Travel Smart Grant Application Number(s) and Corresponding Year of Application
For Official Use Only
Travel Smart Grant Application Number:

Section 2 –DETAILS OF MEASURES TO BE FUNDED

To list in detail the Travel Smart measures that the Organisation is seeking funding for

S/No / Travel Smart Measure / Development/ Operating Initiative / Description of Items/Services / Estimated Unit
Cost (S$)[7] / Qty / Estimated Total
Cost (S$) / Estimated Claim Amount (S$)

Section 3 –DETAILS OF INDIVIDUAL TRAVEL SMART MEASURES

To describe in detail the Travel Smart measure which the Organisation wishes to seek funding for and how they relate to the overall Travel Smart objectivesand how they support the implementation of flexible work arrangements in the Organisation.

(Note: Use one copy of this page for each Travel Smart measure. Organisation is to submit as many copies of this page as appropriate.)

Proposed Travel Smart Measure

CHALLENGES

a)What are the current challenges that your company is facing?

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

DETAILS OF PROPOSED TRAVEL SMART MEASURE

a)How does this proposed measure supportthe Travel Smart objective(s)?

…………………………………………………………………………………………………………………………………………………………………………

b)How does the proposed measure contribute towards the above-mentioned Travel Smart objective and the implementation of flexible work arrangements?

EXPECTED INDICATORS FOR THE PROPOSED MEASURE

a)Please highlight the possible indicators (where possible) that can be used to measure theresultant quantitative and qualitative benefits?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Section 4 – Declaration

To be completed by applicant Organisation

Yes / No

The Organisation is solvent and no liquidation or winding-up proceedings have been commenced or are pending against it.

There are no unsatisfied judgments outstanding against the Organisation that will materially impact the solvency of the Organisation.

Neither the Organisation nor its proprietor (in the case of a sole proprietorship), directors (in the case of a corporation), partners (in the case of a partnership, limited partnership or limited liability partnership) or members (in the case of any other unincorporated association) has/have been convicted of any offence involving fraud, misrepresentation and/or dishonesty.

There have been/are no prosecutorial or civil proceedings commenced/pending against the Organisation or its directors (in the case of a corporation), partners (in the case of a partnership, limited partnership or limited liability partnership) or members (in the case of any other unincorporated association), in the last 10 years preceding the date of this declaration for fraud, misrepresentation and/or dishonesty.

The Organisation and/or its directors, shareholders, employees or any other person related to the aforesaid persons has/have not been given any monies, loans, rebates, discounts, refunds, liquidated damages or any other payment, whether in cash or in kind, by consultants or vendors or their directors, shareholders, employees or any other person related to the aforesaid persons, in connection with the Travel Smart programme or this application form; and there is no intention to give such monies, loans, rebates, discounts, refunds, liquidated damages or any other payment.

The facts stated in this application and the accompanying information are true, complete and correct to the best of my/our knowledge and belief and that I/we have not withheld/distorted any material facts.

I/We understand that if I/we obtain the grant by false or misleading statements, I/we may be prosecuted, and in addition, LTA may, at its discretion, withdraw or cancel the grant in full or in part and recover immediately from the Organisation any amount that may have been disbursed.
Signature & Organisation Stamp
Name
Designation
Date

Only the following representatives are permitted to sign this declaration: